The Unkindest Cut: Countdown to a C-Section

My introduction to Elizabeth Cooper-Schultz comes by way of a text message in which she refers to Mary Birch as “that hospital that claims to be mother and baby friendly.”

When I arrive at the apartment she shares with her husband and two children in the UTC area, Cooper-Schultz welcomes me into her home with a hug, a cup of coffee, and a plate of strawberries and coffee cake. Once we’re seated, Cooper-Schultz begins. She’s eager to tell the story of her son’s birth.

“Usually I start off by telling people my C-section started even before I got to the hospital. I had a C-section because my doctor didn’t care if I had a C-section.”

According to statistics compiled by the Office of Statewide Health Planning and Development, Sharp Mary Birch Hospital for Women and Newborns had the highest rate of cesarean section deliveries in San Diego County in 2009. The California average was 29.8 per 100 births; at Sharp Mary Birch, the rate was 37.7. The World Health Organization suggests that C-section rates should be between 10 and 15 per 100 births.

“I had a C-section because my doctor didn’t care
if I had a C-section.” — Elizabeth Cooper-Schultz

Image by Howie Rosen

At 40 weeks, two days prior to her due date, Cooper-Schultz’s water broke, though she was not in labor. In a birthing class she’d taken at Mary Birch, she’d been told that this happens to 25 percent of women. She says she’d never recommend the class “because it’s focused on the assumption that your birth will be intervened on in some way.” If your water breaks, they told her, we have to get the baby out within 24 hours. So she and her husband went to the hospital right away.

“They pretty much wanted to put me on Pitocin the minute I walked in the door because I wasn’t having regular contractions,” she says.

Pitocin is a synthetic form of a natural hormone called oxytocin that stimulates uterine contractions. The drug is controversial not for what it can do — help induce labor — but for its overuse as a tool of convenience, for managing or controlling labor, despite the risks it presents, including, in rare cases, uterine rupture and fetal distress.

Dawn Thompson, a private doula, or birth coach, based in Encinitas, calls Pitocin the first in the “snowball effect” of interventions that ultimately lead to a C-section. The contractions induced by Pitocin come strong and fast, unaccompanied by the endorphins present with natural contractions, and the use of Pitocin requires constant fetal monitoring, which limits mobility for the mother. Most women find the pain intolerable and end up needing an epidural. An epidural is an injection into the bony spinal canal of a local anesthetic that blocks nerve impulses in the lower half of the body. While epidurals eliminate pain, they come with their own set of risks, potentially slowing down the process of labor, causing a drop in blood pressure for the mother, and causing a lower heart rate for the baby. Ultimately, these interventions set the stage for the C-section.

Mary Birch administrators do not deny that their C-section rate is high. John Cihomsky, Sharp’s vice president of communications, wrote to me in an email, “Sharp Mary Birch Hospital for Women & Newborns is the busiest high-risk, Level III delivery center in the state. Sharp Mary Birch not only delivers the most babies in the state, but we also deliver the most babies weighing less than 1500 grams. These very low birth weight babies are almost always delivered by cesarean section. In addition, we also care for many mothers with high-risk perinatal conditions, such as placenta accreta, and medical conditions that often require delivery via cesarean.”

Hospital administration declined to give me a tour of the hospital or a face-to-face interview.

To be fair, Mary Birch is but one hospital among thousands across the country whose C-section rates are two to four times higher than they should be. And it’s likely that the “too posh to push” crowd and the “I want my kid born on Valentine’s Day” moms do their fair share to raise these rates with their elective C-sections.

But a significant number of women believe their C-section deliveries at Mary Birch were the result of convenience for the doctors, fear of litigation, and/or lack of staff training in nonmedicated childbirth options.

A study done in Portland, Oregon, in the late 1990s found a correlation between the use of Pitocin and C-section rates. The January 1, 2003, issue of Ob.Gyn.News outlines the study, in which 4635 women who went into labor spontaneously had an 11.5 percent C-section rate, while 2647 who were induced had a rate of 23.7 percent.

On the Drugs.com website, an “Important Notice” accompanies the indications and usage information about Pitocin.

“Elective induction of labor is defined as the initiation of labor in a pregnant individual who has no medical indications for induction,” the notice reads. “Since the available data are inadequate to evaluate the benefits-to-risks considerations, Pitocin is not indicated for elective induction of labor.”

It is common for hospitals to use Pitocin if a woman has not gone into active labor within 24 hours after her water has broken to avoid the risk of infection. But the staff at Mary Birch wanted to give Cooper-Schultz Pitocin within the first two hours.

Cooper-Schultz refused the Pitocin at first. She wanted to get things going naturally, and for the next several hours, she and her doula walked and used the birth ball, a large physiotherapy ball on which the mom can sit to relieve pain during labor and which is believed to assist in positioning the baby. At the 12-hour mark, her cervix had dilated to four centimeters. She says she now understands that this “is a good natural labor progression for a first-time mom.”

But it wasn’t fast enough for the staff at Mary Birch. Cooper-Schultz, who describes herself as the kind of person who will “try not to be a problem because you might be mean to me if I am,” allowed them to give her the Pitocin that she says they’d been pushing since she’d arrived.

Comments

Delivering babies used to be an art that OBs were proud to practice. Now, fear of malpractice suits has made them afraid to do anything but the easy, quick births after easy quick labors.

On a personal note, when my son was born at Mary Birch, after a mildly tricky delivery, my wife's OB -- who still practices the art of delivering babies -- whispered in my wife's ear, "I'm glad I got here. The on-call doctor would have had you in surgery for sure."

How a Hospital that is so quick to slice open women can call itself a hospital for women is beyond me.

Chy Z. says: I had my daughter at Mary Birch and yes I did have a c-section. But I was there over 24 hours before it was even suggested. No one there ever persuaded or led me to make a decision to have the c-section. It was actually quite the opposite. My Dr had always told me natural birth is the goal. Even when I had said I was not really looking forward to a natural delivery. The reason that the c-section was necessary was because my baby was trying to push through and I couldn't dilate enough to let her pass through. This decision was made late at night after we had waited almost 30 hours for it to happen naturally and only when it became a safety issue for my baby.

I’m disappointed to see such one-sided reporting in this article. After an unexpected complication at the end of an otherwise normal pregnancy meant my daughter needed to be delivered by an emergency C-section at Mary Birch, I have a bit of a different perspective. My condition was very serious, but my nurse spoke to me calmly, held my hand, wiped my tears, and told me she would stay by my side. The neonatologist and nurses who spent what felt like several minutes reviving my daughter after she was born patiently told my husband, “This is why we’re here,” as he asked repeatedly whether she would be OK.

This article fails to acknowledge that these are people have devoted their lives to caring for others. Their devotion comes at a price; they have most certainly had to deliver terrible news to parents expecting bundles of joy. This article also misrepresents the risks of childbirth. Sure, it’s natural. It’s also quite natural for women and babies to die in childbirth.

After my second daughter was born at Mary Birch, I roomed beside a woman who had nearly done just that. I could hear her husband in the hall as he explained to a relative on the phone what had happened. His wife had started bleeding uncontrollably after an otherwise “normal” childbirth. She seized in the delivery room and then coded three times on the operating table as surgeons performed a hysterectomy that would ultimately save her life. The young father had glimpsed a lifetime without his wife that night, and it tempered his disappointment that they wouldn’t have more children. “She’s going to be OK,” I heard him say, “And so is the baby. And that’s all that matters.”

He had come to realize what the nurses and doctors at the hospital also know: nothing impacts a birthing experience more severely than a tragic outcome. And in the end, a healthy baby and a healthy mom are all that matter. Thankfully – and often due to the benefit of the “interventions” this article blasts – these caregivers get to share in new parents’ joy far more often than they comfort unthinkable loss.

Ms. Salaam makes these heroes out to be villains. But I know something she doesn’t: the way the blonde curl at the base of my daughter’s neck feels when I run it between my fingers. It’s something I get to experience every day and it’s far bigger and better than any experience I might otherwise have had on the day she was born. I’m forever grateful to the people who made that possible.

I'm all for natural birth- but if you'd asked any of those women you interviewed who they would have blamed (and sued) if they'd been left to make a decision and the baby didn't make it, they would all say the medical staff should have intervened and prevented it. Doctors and nurses have seen all kinds of senarios, and the one thing they know for sure is that a c-section is "doing all they can to assure a positive outcome" so that they don't get blamed and sued.All these women went to the hospital to have a healty baby, and they did so give it a break. Hospitals have guidelines to prevent lawsuits, because that's the answer now to anyone dissatisfied with ANYTHING. BLAME SOMEONE is the modern worlds' mantra

pb1, I think you missed the entire point of this article. Of course everyone is thankful for medical interventions to save the lives or mothers and children who have medical emergencies and complications in child birth. The point of this article is to point out that routine intervention WITHOUT a medical indication is CAUSING complications. I was bullied into an induction that was not necessary and was only needed because of an inpatient doctor, was not given any informed consent by either my doctor or the hospital, was not told the risks of the use of pitocin and was treated horribly during my emergency C-Section. I wanted a VBAC for my second and when I was at Mary Birch for a minor procedure to turn my breech baby, the nurses there were NOT supportive of my choice to have an all natural VBAC. My baby, my body, my choice. C-Sections that are not required for medical reasons lead to more complications and riskier future pregnancies and I knew I wanted more children. Thank god I found an amazing provider and went to Pomerado and had the unmedicated VBAC I wanted. Women deserve choices and you cannot have choices unless you know what they are and are given informed consent. Had I known that I was twice as likely to have a C-Section if I was induced, I would not have agreed to it. Had I known Pitocin can cause fetal distress, I would not have agreed to it. If my baby was in danger, of course I would have agreed to anything, but that wasn't the case. It is not unreasonable to expect your doctor and the hospital to give you informed consent and its amazing to me that something that should be routine practice in medicine we have to fight for. Ridiculous.

PB1, you're missing the point. Nobody's saying a baby born via c-section is any less wonderful than a baby born naturally.

The point is: Mary Birch calls itself the hospital for women, yet their c-section rate is very high -- three or four times what the World Health Organization says it should be. A hospital that claims to be in tune with women's particular needs should have a lower than average c-section rate than average.

The question then becomes why is MB's higher? I think this story supplies some answers -- i.e. delivery "on the clock," pitocin, epidurals, immobilized labor, forced fasting, and more.

If nothing else, it's good that Mary Birch should be challenged to do better on this point.

I've seen three children born there. The staff of nurses are mostly hard working and caring. But one quickly gets the feeling that they have a system and a timeline in mind for all births, and they don't like variations from either.

The on-call doctors we saw the last time did very little to disguise how bored and annoyed the was to be called in.

Frankly, the environment is not nurturing. It's cold, clinical... almost industrial.

A comment made here states: "And in the end, a healthy baby and a healthy mom are all that matter." It's incredible how often this is uttered, yet how painfully unbearable this is for many c-section recovering moms to hear. True, the ultimate goal is for mom and baby to be healthy, but at what cost? Many women have been devastated and left to feel helpless and violated as the result of an unwanted cesarean. True, these can be life-saving operations, but only about 8-10% of them are truly necessary. The rest are often brought on by unnecessary procedures in a process that can most often occur naturally and without interventions.

Please know that there is help for women who are traumatized or otherwise upset by their cesarean experiences. The International Cesarean Awareness Network (ICAN) is a non-profit advocacy and support group working to improve maternal-child health by preventing unnecessary cesareans through education, providing support for cesarean recovery, and promoting Vaginal Birth After Cesarean (VBAC). I encourage anyone to visit their main website for more information. Their White Papers are incredibly informative and helpful: http://ican-online.org/

I don't believe I missed the point, but clearly mine was missed. That is, simply, these doctors and nurses have significantly more childbirthing experience than any of the women cited in the article. And that, as a result, they likely know things these mothers couldn't possibly.

Wouldn't a hospital that delivers the most babies under 1,500 grams (that's less than 3.5 pounds, by the way), naturally have a higher c-section rate than other hospitals in the state? And consider that the woman with twins was turned away from a birthing center. Multiples are high-risk births, so they didn't want the liability. She went to Mary Birch, like many other high-risk pregnancies, according to the article.

So while I understand the point that these women believe these rates reflect unnecessary C-sections, I wonder how they can be so sure when they don't have the benefit of years of experience nor access to the clinical data behind the numbers.

katiakata, I wonder whether your "My baby, my body, my choice" comment also applies to the "too posh to push crowd." Do they not have as much of a right to the birth experience they choose as you do? And perhaps your description of the procedure to turn your baby as being "simple" may be a bit, well, simplified. There are reasons they do that procedure -- an intervention itself -- in the hospital. The cord can get tangled or pinched, cutting off the baby's oxygen supply. It alone could have necessitated an emergency c-section.

Aquarimary- you're proving the point that one of the reasons that hospitals heavily rely on c-sections is to purely avoid lawsuits. OBs are among the top tier in malpractice suits and have incredible malpractice insurance premiums. (I have friends who are practicing OBs) So it ultimately does come down to risk management- the doctors are risk-averse and just about every one I know (including my friends) would prefer to go down the path of least resistance. So if there is any type of challenge in the labor process, they will use a medical intervention rather than trying natural methods.

By the way, I AM one of the women who were interviewed in the article and the whole idea that "you should be grateful you have a healthy set of twins" and "why are you complaining that you had to endure major abdominal surgery" this is very insulting. In my case, there was never any type of health issue or anything out of order. no medical emergency. So to answer your comment- my babies' health and safety was never part of the reason to have a c-section.

This article is one sided and unfairly represents Mary Birch as an organization. I have had both of my kids at Mary Birch the first one was a c-section after labor for 23 hrs, the second was a VBAC (vaginal birth after c-sec.) and we were in labor for 36 hours. With my first child they tried everything and alas the labor wouldn't permit us to have him vaginal. and the second one my wife really wanted to have the VBAC and the doctors did everything to make that happen. And the fact now that they are going to rally outside the hospital is making my blood boil. I understand the need for a vaginal/natural birth trust me, but some women either don't have the genetic make up or a problem free labor that would be conducive to that end. Further more the fact that Mary Birch has more high risk pregnancies and also the most babies BORN under 1500 grams in the state is something you should be praising them in their efforts not putting them on the cross because some peoples birth didn't goes as they wanted. But for all of those who feel a rally is important and you don't want to have c sections feel free to have your babies at home like they did 200 years ago, where i might add 50% of women or their babies died in child birth.

I have to say I agree with fred2468. The women (with good insurance) who deliver at Mary Birch are usually high risk. It is a hospital that specializes in complicated births or multiple pregnancies so of course their c-rates will be higher than other hospitals. If you want to luxuriate in homey birthing rooms, find another hospital.

Every book you read and class you attend before childbirth always instructs you to state your preferences for a birth plan but be open to changes and flexible. That means if something goes wrong or the labor is not progressing, sometimes you have to bite the bullet and do what needs to be done to get that baby out safely.

Women have some kind of rose-colored glasses on to think that it will be a walk in the park to have a baby. It is dirty, painful, and fraught with danger but also the most wonderful thing in the world. You can say you want to do it "naturally" all you want but it doesn't always work out that way. I wanted "natural" too but with my back labor feeling like a knife slicing by spine with every contraction, I opted for an epidural and thanked God for it and the relief it brought me! My son decided to break my water at a most inconvenient time so I knew I would be getting the pitocin. Oh well, there goes my second attempt at "natural birth." But I didn't care about my so-called desire to have an organic birth at that point. I just wanted a healthy baby to come out any which way possible.

Some people need to count their blessings and stop the whining. It sets a bad example for those precious children you were lucky enough to give birth to, which ever way they came out!

Fred2468, first I would like to be really clear that the Rally for Change is not about SMB. I realize this article does not show SMB in a kind light but the Rally was planned long before the article came out. We chose the word Rally vs. Protest very thoughtfully. This is a peaceful demonstration asking for evidenced based care. The rally is to bring awareness and education to the OUT of CONTROL Induction and C-Section rate in this COUNTRY, not just at SMB.

In 1964 the national c-section rate was 6% and the most recent numbers just released for 2010, the rate is 36%. This means that more than 1 out of every 3 women is having major abdominal surgery in order to bring their child into the world and yet the infant and maternal mortality rate has NOT changed. This is the reason for the Rally. I believe that there are a lot of dedicated nurses and staff that work at SMB and that SMB is already working to make changes in their policies to reduce the c-section rate, which by the way they agree is too high. The Rally is meant to educate the public about their responsibility to educate themselves. We are not here to judge what path women take during THEIR birth, be it medicated, non-medicated or surgical. What we are demanding is for these women to have FULL INFORMED CONSENT, which is the LAW. You have the experience of your 2 children. I have the experience of hundreds of births. You nor the hospital is the one that has to hear these women, who have been traumatized by theirs birth say things like "if I had only known that could happen".

Here is the press release below about the Rally. I encourage you to read it and really educate yourself about the subject. I appreciate your desire to support the hospital where you and your wife had such a positive experience, but the numbers tell a story at SMB and all the other hospitals in this country. Numbers don't lie. By the way, no where near 50% of mothers and babies died in home birth 200 hundred years ago. Most home birth midwives even today have c-section rates well under the World Health Organizations recommended rate of 10%.

Hey Sandoula i like how you assume I haven't educated myself on these stats and I like how you assume that the hospital doesn't already FULLY INFORM THEIR PATIENTS. Knowing how the medical guidelines are they have to fully inform and they do!!!!
And Secondly if you have a rally planned about all hospitals why are you choosing the one that is mentioned in the article and not another hospital? You guys are jumping on the bandwagon, sorry that this hospital births more babies than any other hospital in the STATE so it's c-sec's are higher than any other in the state. But sure bring awareness if you read my post we had both a c sec and a VBAC so obviously we understand both sides.
And yeah your home mid wife c sec could be well under the 10% mark but doesn't change the fact that with the advancements in modern medicine, with epidurals and better improvements to a c sec, more babies and moms now SURVIVE the birthing experience.

Fred2468, I have obviously offended you. This is sometimes the problem with the written word when you can't hear the inflection in someones voice. I was merely trying to explain the purpose of the rally. As for Full Informed Consent. I have witnessed on many occasions the absents of informed consent. Just handing a legal form with all the risks for them to sign while in labor or preparing for the induction doesn't mean informed consent. Women are not being told that if they get induced before their baby is ready, there is a greater than 50% chance of c-section. I could go on and on about the risks of low blood pressure, of fetal distress or the many other highly potential side affects to induction. Families are not being told this, therefore, it is not informed consent.

I also want to be clear that we are not talking about the high risk pregnancy. We are talking about the mass population of healthy birthing women. I will repeat this, In 1964 the national c-section rate was 6% and the most recent numbers just released for 2010, the rate is 36%. This means that more than 1 out of every 3 women is having major abdominal surgery in order to bring their child into the world and yet the infant and maternal mortality rate has NOT changed. How can you justify this? How is that ok?

On Saturday, December 17th at 10am – 12pm, hundreds of women, men and children will gather in front of Sharp Mary Birch Hospital for Women in a “Rally for Change”. In 1964 the national c-section rate was 6% and the most recent numbers just released for 2010, the rate is 36%. This means that more than 1 out of every 3 women is having major abdominal surgery in order to bring their child into the world says Dawn Thompson of San Diego Birth Network. This peaceful rally is meant to help educate new mothers about the risk of both elective induction and elective c-section.
The rally for change is meant for the vast majority of the birthing female population that has normal healthy pregnancies. Dawn goes on to say “Women deserve evidence-based care that is based on scientific studies, not tradition or "doctor convenience" based care.” The definition of Evidence based care is; the conscientious, explicit, and judicious use of current best evidence in making decisions about the care of individual patients. Many women are being told dubious things like; their baby is too big, pelvis too small, and low amniotic fluid, even after all of the studies have shown that the means in which they measure these things are grossly inaccurate. The greatest cause for induction, which 50% of the time ends in c-section, is going past their due date. Most doctors do not support a women going past 41 weeks even though their own governing agency, ACOG, states that post dates is not until 42 weeks. Even more incredulous is that many inductions are happening before 39 weeks of pregnancy.
The Rally for Change is meant to make a statement and encourage birthing families to do their own research and understand the clear risks and consequence to elective induction and elective c-sections. Any induction that does not have a “specific medical indication”, such as Pre-Eclampsia, which the life of the mother or baby is in mortal danger, is considered elective. Women are daily misled by their doctors about the easy and casual affects of induction. Women are being traumatized by their birth experience and given arguable reasons for why their induction failed. Doctors rarely state the possibility that the failure was caused by intervening before mother and baby were ready for birth.
Birth trauma specialists like Mary Obata, MFT, see women suffering from PTSD reactions caused by birth experiences that did not go as planned. She states, "I treat women with symptoms that include flashbacks and trouble bonding with the baby from inductions that resulted in complications and c-sections. The emotional and behavioral consequences are serious for both mother and baby."
If you or someone you know, believes they may have had an unnecessary induction and or unnecessary c-section, please come and stand with all the other families to support this Rally for Change. Change only happens when consumers demand it.

Fred2468, I would also be interested to know, when you say they tried "everything" during your wife's first birth, did this include discussing the possibility of cervical scar tissue? Have you even heard of that? Did your wife get in many different positions, like hands and knees to encourage the baby to shift in the pelvis? There really is no reason to answer that, because I have been working in hospitals for almost 10 years, I know they didn't. That's what a doula or midwife would do. The doctors and nurses never even get trained on how to do these things. People don't know, what they don't know. We are trying to help educate them. The best decision is an EDUCATED ONE.

I like how you assume yet again that you know everything! They did go over all the things they could do but yet again we were on a time table as her water broke and it had almost been 24 hrs since then. But by all means keep up the view that you are always right even when you know nothing about what was said while we were in labor because last I checked you weren't there.
But thanks again I love that you are on this high horse with we need to have everyone educated and yet you assume a lot about people. we have a friend who is a doula and she gave us all the info that you just spouted off, and we still had to have a c sec. And my 10 lbs 23 inch long baby boy was delivered safely, healthy, and without harm 4 years ago today.
So please Sandoula take a step back off your high horse and try to not make assumptions about me and my children because we all know what happens when someone assumes...

The comment you made here about the "time table" proves my point exactly. Research does not support the 24 hour clock, but shows that 90% of labors start spontaneously within 48 hours of rupture and that little to no vaginal exams should be done during that 48 hour period to reduce the risk of infection. This is current, published and supported information by ACOG and yet doctors are still using the 24 hour clock. I am in no way saying that your c-section wasn't necessary, you are right, I wasn't there. Honestly the point I was trying to make is that Doctors and Nurses aren't even trained in "everything" that can be done. It sincerely wasn't to insult you or your wife's birth experience. It was to share the perspective that we as birth professionals have. Anyone who knows me, knows that I do not live my life on a "high horse". I am a loving, kind and devoted professional. Who left her corporate America career to serve women. I truly believe based on my experience and the experience of the thousands of other birth professionals around this country, that things need to change. So we will Rally for Change tomorrow morning and again in the future at another hospital in town. If you are at all truly interested in the other side of the story, I would encourage you to check out an OB by the name of Dr. Stuart Fischbein who is extremely outspoken about the current state of OB care, or look up youtube video on Marsden Wagner or Ina May Gaskin or Robin Lim, who won the CNN Hero of the year award Sunday night. I appreciate your perspective, I just don't agree with it based on my experience.

The fact of the matter is that you still assumed we weren't informed and assumed that although maybe the nurses or doctors didn't tell us the info that we'd already had prepared and learned, but doesn't mean those methods weren't used. and given the size of my baby and my wife there was no way she would safely be able to deliver him naturally and a c sec was needed. and my wife is more prone to infections so although yes we could have gone to the 48 hr mark we didn't want to risk it based on her prior medical history. And you are right doctors and nurses aren't trained on everything but neither are doulas and midwives which is why I had both sides talk to my wife before we had our first child.
And don't worry you didn't offend me just find it funny how you assume you knew everything about how our birth went. But to give you the benefit of the doubt I will look into Dr. Fischbein and see what he has to say. and believe me I appreciate your view I just strongly don't agree with it.

Fred, don't you think that Doctors and nurses who are supporting the mass population of healthy birthing mothers should have training in all things related to birth? You and I can finally agree on one major point "And you are right doctors and nurses aren't trained on everything but neither are doulas and midwives" The point being all women need a midwife and/or doula in order to be fully educated and informed about birth and that the doctor should only cover his expertise and assist when only medically necessary. There are 2 sides and families need to educate themselves to make a Informed choice. Which sir was the exact reason for our Rally for Change yesterday. Thank you for an open mind and a great debate. :)

I used to work at S.M.B. as one of the newborn baby photographers. We always had a list of normal births and C Section births to work from and I was always appalled at the number of C Sections. I found it to be 40% to 50% C Section. Totally unnecessary putting lives at risk just to rake in more money. I am glad to see that someone is speaking up on this issue as this always bothered me.

I just wish that it had been thoroughly explained to me that if my birth didn't progress while on Pitocin, that the "dry" contractions could cause the baby's heart rate to drop dangerously (fetal distress), which would necessitate an immediate C-section.

I was under the impression that if the Pitocin wasn't helping, that it could be stopped and delivery could be postponed until my body did respond to it another day. Instead, once the bells and whistles started going off due to the baby's slowed heart rate, I was whisked into surgery and was given a C-section within minutes.

My baby was so unready to be born that she still hadn't dropped into my pelvis. Despite pushing and tugging hard, the OB's couldn't even pull her out once I was cut open and they had to perform a rare delivery: a forceps-assisted C-section.

This was not at Mary Birch, but it was at a major medical center. It occured at 37 weeks due to a maternal medical problem (severe cholestasis of pregnancy, non-emergency).

Listen - for those of you who are concerned that SMB was unfairly represented, its worth noting that THE HOSPITAL WAS OFFERED THE OPPORTUNITY TO PARTICIPATE IN THIS ARTICLE. THEY DECLINED. If they feel unfairly represented then that is their own fault. The article easily could have reflected something entirely different had the administration offered the reporter the interview and facility tour that she requested.

If you blame the reporter for being one-sided, then you've done her a disservice.

Next? It has been said and said again - the "natural" birthing community (which is not a bunch of hippies) is MORE concerned with women being offered the opportunity to give INFORMED CONSENT. If you know ALL the risks and the secondary effects of the decisions you make, and you still want the induction/augmentation/c-section, then bully for you. Women who receive treatment without being fully informed often feel misled, lied to, deceived... and in some cases its as severe as feeling assaulted. I supported a mother who experienced an AROM without consent while having a vaginal exam during labor. I cannot tell you how violated she feels to this day. She has every right to feel betrayed by her care provider.

This is an issue of American OB's not being held to the standards of "FIRST DO NO HARM". Too many operate for their own convenience and don't honor their patients. Too many poo-poo women who experience this only a few times in their life and who understandably have questions and concerns about what they are experiencing. Birth is natural. It has happened without OB's and without surgery for centuries and the human race is still here.

The US spends MORE money than any other country on birth. Why are we not at the TOP of the list for positive maternal outcomes? A c-section in the US costs an averages of 12-15k. A vaginal birth averages 7-9k. Despite spending the most we are 42nd in maternal mortality rates. 41 countries do a better job than we do and they spend less money. WHY IS THAT? How do you justify the increase in c-section rates and zero change in maternal mortality?

This is about educating the public. This is about informed consent. This is about not suffering at the hands of physicians who want your birth to fit their standards and slide into a neat little box. Birth is unpredictable. Birth is unique every single time. Birth is messy. Birth takes its time.

Research your doctor. Research your hospital. Hire a doula. Know before you go.

It's easy for me to say this article is one sided because if your desire was to bring the rise in c sections across the nation/state/county the reporter would have interviewed women from all the hospital systems in the county. And that could have been a very easy task to do since there are plenty of births but it was easier to pick on the biggest one and just gloss over why the stats would be higher than other hospitals. (most births in the state, most high risk pregnancies, and most babies under 1500 grams.)
Further more I like how you claim it was only sharp to blame because "THE HOSPITAL WAS OFFERED THE OPPORTUNITY TO PARTICIPATE IN THIS ARTICLE. THEY DECLINED" but I like how you never tried to find the women who had a good experiences to show the other side. Instead you chose women who only had negitive. How is that not one sided. You found a easy story that you could sensationalize into fitting what the reporter wanted without having to really show the other side for their agenda (for lack of better words) to get accomplished.
If you really wanted to do an expose on the rise in c sections you would've put more effort instead of a slam on an easy target. but if the reader and the reporter feel they were fair in showing both sides, you probablly wouldn't have had to defend the article.

To answer your comment to me pb1, of course I had my version in a hospital. I am not anti-hospital. I was given ALL the facts, risks and benefits on the external version and my husband and I made the decision accordingly. I did agree to this intervention, but only after knowing the facts. That is all I ever wanted for my first pregnancy and birth as well. I would not have had to make that choice if their had been an OB who was skilled in breech delivery, but unfortunately that is an art that has been lost here in the US and a differently discussion all together. So, we chose the the less invasive intervention. Luckily, with a little nudge and less than a minute of work, she flip flopped head down and stayed there. To your other question, yes, I 100% support anyone who chooses to have an elective C-Section, IF they are given all the facts. I WAS NOT given any facts on my induction. My informed consent included only being told "don't worry I do this all the time, its perfectly safe." That is not informed consent. It took me a year to recover from my C-Section, I had several infections and had severe pain for many months. It was over a year before I could return to running without any pain. My friend had a complication and ended up with a hysterectomy and she will never had children again. She was told she should have a C-Section because she was having a "big baby". That big baby turned out to be 8 pounds and she will never have anther. She was also told that "C-Sections are perfectly safe and there was nothing to worry about." I have heard this story time and time again. Women are NOT being given all the risks associated with induction/ elective C-Section / Pitocin... etc.. This is the focus. INFORMED CONSENT. I don't think that is being unreasonable at all and all women should want to know all the facts before making major decisions for themselves and their babies.

Jessica W. says: I used to work at S.M.B. as one of the newborn baby photographers. We always had a list of normal births and C Section births to work from and I was always appalled at the number of C Sections. I found it to be 40% to 50% C Section. Totally not necessary putting lives at risk just to rake in more money. I am glad to see that someone is speaking up on this issue.

Elizabeth M. says: There is an epidemic of c-sections in this county. We are the only country in the world that treats pregnancy and birth like it's a disease or medical condition.

I will be having my baby at the UCSD birth center with a midwife and doula. No drugs, no drama, just going to let my body do what it already knows how to. Women have been giving birth for 50,000 years without medical intervention.

I understand the issue being addressed here but wow, so one-sided. The doctors and nurses at SMB save lives every day. I am so grateful to them for what they did for me and my children that this article makes me very sad. The author couldn't find one person with a good story to tell? Clearly, she didn't look for one. And while I understand that everyone has a personal story to tell, the statistics are being looked out out of context. So many micro preemies and multiples are born at SMB so of course the C-section rate is higher. Even comparing C-section rates back to 1964 or whatever someone quoted is misleading. Things have changed. Many more women do IVF and, while I haven't looking up the statistics, there are many more multiples being born. While multiples don't always require a c-section, the rates are definitely and justifiably higher than singleton births. Anyway, I just feel bad that such an amazing place is being presented in such an unfair light.

Wow. Having had a tragic experience, I cant help but notice all these women have healthy living children. That alone is a successful birth in my eyes. If you have ever had a fetal demise, all of your viewpoints would be "better safe than sorry". And if "overly safe to avoid lawsuits" is unappealing to anyone, go have your child at home, no one is stopping you. These days the c/s rate is up because many women having babies are older, overweight, and have more medical problems. The fetal monitoring might be excessive but at least you know when your baby is in trouble. Yes, SMB may have a high c/s rate but I would undergo ANY surgery on earth for a healthy baby. Im sorry these people did not get the sunshine, cupcakes and rainbows birth stories they wanted but if they all went home with healthy babies, the hospital did it's primary job. Be thankful. It's not about your "story" it's about your child.

There is another reason that the number of C-sections has increased. Trial lawyers found a gold mine in suing hospitals and doctors for infant maladies that they falsely blamed on situations that the lawyers claimed could have been avoided had a C-section been done.

This is a super timely article, as I'm currently seven months preggers. After submitting my birth plan to my doctor who delivers exclusively at Mary Birch, I was told that she does not support delayed cord clamping. I called another really reputable practice--- to see if I could find another option, another Mary Birch doctor. The second practice I called has about six doctors including some of the best perinatologists who work at Mary Birch. The coordinator (not the receptionist) there had not even heard of delayed cord clamping... which I did not think was "so radical." Heck- there was an article in the NYT science section in support of it on Nov. 28, 2011.

Anyway, after being shot down twice, I finally called the UCSD Birthing Center. Not only are they family with this procedure and are "ok" practicing it, they say many women opt to do it (very unlike the response I rec'd from the Mary Birch doctors).

It is really unfortunate b/c my husband and I do not consider ourselves hippies and really wanted to deliver at Sharp/ Mary Birch (where he was born). We just want some natural, non-medicated options, but the more we investigate and hear about Mary Birch, their nurses who are not so familiar or welcoming of natural options, we do not feel that this is no longer an option for us. We are among the lucky ones in that our insurance allows us to choose whatever hospital we want...

In terms of PR/crisis communications, I definitely think that Mary Birch spokespeople should have addressed the issues posed in this article- they chose not to comment/respond... and by offering some doula training sometime in 2012 is not much of a solution. I realize that changes do not come overnight. In the meantime, it is likely that Mary Birch will continue to have the reputation of being not-so friendly, knowledgeable or welcoming of natural, non-medicated deliveries.

Thank you for this article. It basically sealed our decision to switch to UCSD (or Scripps).

This is a blatant puff piece for the doulas. The author parades a handful of dissatisfied mothers (who, far as I can tell, all delivered healthy viable infants)and cites the expertise of a doula with a whopping 134 births in 8 years, a little over 1 per month, then interviews how many physicians or satisfied moms? None. She cites the WHO recommended c-section rate of 10-15%, and tries to apply it to a high-risk tertiary care hospital in a major US city. Can one rate be equally applicable to all patient poulations everywhere on the globe? One subject of the story is upset that she consented to a c-section even though she had been in labor for 40 hours, but refused suction-assisted delivery, but wanted "anything besides totally hands-off." What!? Now she wants a VBAC at home with a doula and midwife at her side. I wish her luck, because that is what she will need. Nowhere in this article does the author mention the very real complications that can and do occur during deliveries: hemorrhage, seizures, infection, fetal injury, and death. Is it conceivable that physicians are not just concerned about getting sued, making money, or dropping the kids off at school, but perhaps the well being and safety of their patients? I am all for advancing patient care and improving the informed consent process, but biased, pseudo-journalistic articles like this do a disservice to the thousands of dedicated nurses and physicians who help mothers bring children into the world safely every day.

After I read this article I found myself thinking, "wow, that was me".

A week after my doctor's estimated due date (I am certain that their date was early by 2 weeks, and informed my doctor of this. She did not budge and change the date) my husband and I show up at the hospital to be induced. I was given a clipboard full of paperwork to sign and fill out. I have no idea what I was signing or what half of it said, I was about to have a baby, am I really the right person to be looking over such important stuff and signing it? After all of that was taken care of, the nurse set my IV and got the pitocin going, then the doctor said we are going to break your water. I was never talked to about how the pitocin worked and how they used it, or how breaking my water worked, nor was I given any choice between the two. I was new at this baby business, as it was our first child, but I don't feel like the doctor or nurses treated it that way. They treated it as if it was routine for them and just went on about their day delivering babies.

After 10 hours, fetal distress twice, turning the pitocin on and off twice, and finally a high fever from me, the doctor said "we are going to have to do a c-section". When I asked about the possiblity of having a VBAC when I decide to have another child, the doctor's reponse was "we can discuss that when the time comes".

I understand that doctors and nurses go through training and have years of experience taking care of pregnant women and their fetuses and delivering babies, but I think they need to work on how they go about treating their patients. Taking just a few more minutes to listen to their patients and explain things like inductions and how they work and alternatives to using drugs, and giving you options would be some much more helpful. I feel like they just go through the motions to get it done and move on to the next patient. I also understand that with modern medicine there are a lot more women and children surviving child birth, but doesn't mother nature get a say at all? Doctors simply are not that smart. Isn't there somewhere in this process where doctors need to step back and let a women's body do what it has naturally done for so long? If the fit hits the shan then I am all for doctors stepping in to assist, that's what they have been trained to do; assist women having babies.

With all that I have said, I did not have my baby at Sharp Mary Birch, I had him at Scripps La Jolla, where I feel I received very similar treatment to the women in this article. This article points at SMB, but it happens other places as well. Women need to be more informed, and hopefully policies and doctors will change and when they do women will hopefully not have to endure what I, and so many other women have.